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J. Clin. Med. 2019, 8(2), 226; https://doi.org/10.3390/jcm8020226

The Benefice of Mobile Parts’ Exchange in the Management of Infected Total Joint Arthroplasties with Prosthesis Retention (DAIR Procedure)

1
Orthopaedic Surgery Service, University of Geneva, Geneva 1211, Switzerland
2
Balgrist University Hospital, Zurich 8008, Switzerland
3
Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva 1211, Switzerland
*
Author to whom correspondence should be addressed.
Received: 27 December 2018 / Revised: 28 January 2019 / Accepted: 5 February 2019 / Published: 9 February 2019
(This article belongs to the Special Issue Complications in Total Joint Arthroplasties)
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Abstract

Background: The management of prosthetic joint infections (PJI) with debridement and retention of the implant (DAIR) has its rules. Some authors claim that lacking the exchange of mobile prosthetic parts is doomed to failure, while others regard it as optional. Methods: Single-center retrospective cohort in PJIs treated with DAIR. Results: We included 112 PJIs (69 total hip arthroplasties, 9 medullary hip prostheses, 41 total knee arthroplasties, and 1 total shoulder arthroplasty) in 112 patients (median age 75 years, 52 females (46%), 31 (28%) immune-suppressed) and performed a DAIR procedure in all cases—48 (43%) with exchange of mobile parts and 64 without. After a median follow-up of 3.3 years, 94 patients (84%) remained in remission. In multivariate Cox regression analysis, remission was unrelated to PJI localization, pathogens, number of surgical lavages, duration of total antibiotic treatment or intravenous therapy, choice of antibiotic agents, immune-suppression, or age. In contrast, the exchange of mobile parts was protective (hazard ratio 1.9; 95% confidence interval 1.2–2.9). Conclusions: In our retrospective single-center cohort, changing mobile parts of PJI during the DAIR approach almost doubled the probability for long-term remission. View Full-Text
Keywords: antibiotic duration; DAIR; treatment failure; mobile parts’ exchange; orthopaedic surgery antibiotic duration; DAIR; treatment failure; mobile parts’ exchange; orthopaedic surgery
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Hirsiger, S.; Betz, M.; Stafylakis, D.; Götschi, T.; Lew, D.; Uçkay, I. The Benefice of Mobile Parts’ Exchange in the Management of Infected Total Joint Arthroplasties with Prosthesis Retention (DAIR Procedure). J. Clin. Med. 2019, 8, 226.

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